Bladder Pain Syndrome (BPS)

Bladder Pain Syndrome (BPS) is defined as chronic pelvic pain or discomfort that is felt to be related to the urinary bladder with symptoms that include urinary urgency or frequency.
Interstitial Cystitis (IC) is a specific variant of BPS.

The painful symptoms of BPS are believed to be caused by a combination of injury to the bladder lining and autoimmune factors. Bladder lining injury allows irritants found in urine to
irritate the bladder wall, while autoimmune factors lead to increased sensitivity of the bladder.

Patients with BPS commonly experience an almost constant urge to void to relieve pain.

Some patients who carry the diagnosis of Bladder Pain Syndrome/Interstitial Cystitis actually have Pelvic Floor Dysfunction. In these patients, over contraction of the Pelvic floor musculature leads to difficulty voiding which then presents as Painful Bladder Syndrome. Pelvic Floor Dysfunction is treated by Physical Therapy and other modalities that aim at relaxing the pelvic floor.

Evaluation may include urodynamics and cystoscopy.

During cystoscopy, the inside of the bladder and urethra are evaluated with a small camera for abnormalities sometimes found in the bladder of patients with BPS. This can usually be done in the office during your exam. When pelvic floor tension accompanies BPS, physical therapy is usually recommended.

Medications used to treat BPS include bladder analgesics, antihistamines, and Pentosan Polysulfate (Elmiron).

Treatment options also include Bladder Instillation with substances to relieve the discomfort, InterStim for treatment of symptoms of urinary urgency and urinary frequency associated with BPS, and hydrodistention.

Hydrodistention is done during cystoscopy under anesthesia. Fluid is infused until pressure within the bladder is elevated. Patients who respond notice a decrease in symptoms for at least 6 months and may be candidates for repeat hydrodistention.